Options for Masculinizing Genital Gender Affirming Surgery: A Critical Review of the Literature and Perspectives for Future Directions

Djordjevic, 2018, Novel surgical techniques in female to male gender confirming surgery, Transl Androl Urol, 7, 628, 10.21037/tau.2018.03.17 Kovar, 2019, Donor site morbidity in phalloplasty reconstructions: Outcomes of the radial forearm free flap, Plast Reconstr Surgery Glob Open, 7, e2442, 10.1097/GOX.0000000000002442 Ascha, 2018, Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery, J Urol, 199, 206, 10.1016/j.juro.2017.07.084 Kailas, 2017, Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage, Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol, 23, 780 Massie, 2017, Phalloplasty with urethral lengthening: Addition of a vascularized bulbospongiosus flap from vaginectomy reduces postoperative urethral complications, Plast Reconstr Surg, 140, 551e, 10.1097/PRS.0000000000003697 Stojanovic, 2017, One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals, J Sex Med, 14, 741, 10.1016/j.jsxm.2017.03.256 Pribaz, 1994, Prelamination: defining the prefabricated flap–A case report and review, Microsurgery, 15, 618, 10.1002/micr.1920150903 Medina, 2018, Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men, Int Urogynecol J, 29, 1463, 10.1007/s00192-017-3517-y Jun, 2021, Robotic-assisted vaginectomy during staged gender-affirming penile reconstruction surgery: Technique and outcomes, Urology, 152, 74, 10.1016/j.urology.2021.01.024 Jeftovic, 2018, Hysterectomy with bilateral salpingo-oophorectomy in female-to-male gender affirmation surgery: Comparison of two methods, Biomed Res Int, 2018, 10.1155/2018/3472471 Giampaolino, 2021, Robotic hysterectomy as a step of gender affirmative surgery in female-to-male patients, J Invest Surg, 34, 645, 10.1080/08941939.2019.1669744 Lee, 2019, Transvaginal natural orifice transluminal endoscopic surgery for female-to-male transgender men, J Minim Invasive Gynecol, 26, 135, 10.1016/j.jmig.2018.04.022 Gardella, 2020, Surgical outcome for robotic-assisted single-site hysterectomy (RSSH) in female-to male reassignment compared to its use in benign gynecological disease: A single center experience, J Robot Surg Elfering, 2020, Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes, Int J transgender Heal, 21, 138, 10.1080/26895269.2020.1751014 Petruzzelli, 2021, Single center experience of laparoscopic hysteroannessiectomy and histopathological outcomes in transgender men, Int J Impot Res, 10.1038/s41443-021-00408-9 Gomes da Costa, 2016, Laparoscopic vaginal-assisted hysterectomy with complete vaginectomy for female-to-male genital reassignment surgery, J Minim Invasive Gynecol, 23, 404, 10.1016/j.jmig.2015.12.014 Hougen, 2020, Outcomes of transperineal gender-affirming vaginectomy and colpocleisis, Female Pelvic Med Reconstr Surg Ergeneli, 1999, Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: Preliminary report, Eur J Obstet Gynecol Reprod Biol, 87, 35, 10.1016/S0301-2115(99)00091-3 Cohen, 2020, Use of a split pedicled gracilis muscle flap in robotically assisted vaginectomy and urethral lengthening for phalloplasty: A novel technique for female-to-male genital reconstruction, Plast Reconstr Surg, 145, 1512, 10.1097/PRS.0000000000006838 Chesson, 1996, The role of colpocleisis with urethral lengthening in transsexual phalloplasty, Am J Obstet Gynecol, 175, 1443, 10.1016/S0002-9378(96)70088-1 Nikkels, 2019, Vaginal colpectomy in transgender men: A retrospective cohort study on surgical procedure and outcomes, J Sex Med, 16, 924, 10.1016/j.jsxm.2019.03.263 O'Hanlan, 2007, Total laparoscopic hysterectomy for female-to-male transsexuals, Obstet Gynecol, 110, 1096, 10.1097/01.AOG.0000286778.44943.5a Ott, 2010, Combined hysterectomy/salpingo-oophorectomy and mastectomy is a safe and valuable procedure for female-to-male transsexuals, J Sex Med, 7, 2130, 10.1111/j.1743-6109.2010.01719.x Bogliolo, 2014, Robotic single-site surgery for female-to-male transsexuals: Preliminary experience, Scientific World J, 2014, 10.1155/2014/674579 Obedin-Maliver, 2017, Feasibility of vaginal hysterectomy for female-to-male transgender men, Obstet Gynecol, 129, 457, 10.1097/AOG.0000000000001866 Groenman, 2017, Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study, Surg Endosc, 31, 3363, 10.1007/s00464-016-5333-8 Bretschneider, 2018, Complication rates and outcomes after hysterectomy in transgender men, Obstet Gynecol, 132, 1265, 10.1097/AOG.0000000000002936 Redman, 1986, Technique for phalloplasty, Urology, 27, 360, 10.1016/0090-4295(86)90316-X Kim, 2009, Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals, J Plast Reconstr Aesthet Surg, 62, 309, 10.1016/j.bjps.2007.11.011 Garaffa, 2010, Total urethral construction with the radial artery-based forearm free flap in the transsexual, BJU Int, 106, 1206, 10.1111/j.1464-410X.2010.09247.x Song, 2011, Modifications of the radial forearm flap phalloplasty for female-to-male gender reassignment, J Reconstr Microsurg, 27, 115, 10.1055/s-0030-1268210 Garcia, 2014, Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: The Institute of Urology, London U.K. experience, Transl Androl Urol, 3, 156 Terrier, 2014, Surgical outcomes and patients’ satisfaction with suprapubic phalloplasty, J Sex Med, 11, 288, 10.1111/jsm.12297 Jun, 2018, Total phalloplasty with latissimus dorsi musculocutaneous flap in female-to-male transgender surgery, Urology, 120, 269, 10.1016/j.urology.2018.06.032 Wirthmann, 2018, Phalloplasty in female-to-male transsexuals by Gottlieb and Levine's free radial forearm flap technique-a long-term single-center experience over more than two decades, J Reconstr Microsurg, 34, 235, 10.1055/s-0037-1608656 Elfering, 2019, Preexpansion in phalloplasty patients: Is it effective?, Ann Plast Surg, 83, 687, 10.1097/SAP.0000000000001968 Al-Tamimi, 2019, The surgical techniques and outcomes of secondary phalloplasty after metoidioplasty in transgender men: an international, multi-center case series, J Sex Med, 16, 1849, 10.1016/j.jsxm.2019.07.027 Namba, 2019, Flap combination phalloplasty in female-to-male transsexuals, J Sex Med, 16, 934, 10.1016/j.jsxm.2019.02.010 Matti, 1988, Phalloplasty using the free radial forearm flap, Br J Plast Surg, 41, 160, 10.1016/0007-1226(88)90044-6 D'Arpa, 2019, Urethral reconstruction in anterolateral thigh flap phalloplasty: A 93-case experience, Plast Reconstr Surg, 143, 382e, 10.1097/PRS.0000000000005278 Djordjevic, 2019, Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery, World J Urol, 37, 631, 10.1007/s00345-019-02641-w Danker, 2020, Technical description and microsurgical outcomes in phalloplasty using the deep inferior epigastric artery and locoregional veins, Plast Reconstr Surg, 146, 196e, 10.1097/PRS.0000000000007036 Küenzlen, 2020, Multimodal evaluation of functional nerve regeneration in transgender individuals after phalloplasty with a free radial forearm flap, J Sex Med, 17, 1012, 10.1016/j.jsxm.2020.02.014 Falcone, 2020, Suprapubic pedicled phalloplasty in transgender men: A multicentric retrospective cohort analysis, Int J Impot Res Terrier, 2021, Suprapubic phalloplasty in transmen: Surgical results and critical review, Int J Impot Res, 10.1038/s41443-021-00426-7 Falcone, 2021, The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: Single-centre experience and systematic review of the current literature, Int J Impot Res, 10.1038/s41443-021-00414-x Papadopulos, 2002, Long-term fate of the bony component in neophallus construction with free osteofasciocutaneous forearm or fibula flap in 18 female-to-male transsexuals, Plast Reconstr Surg, 109, 1022, 10.1097/00006534-200203000-00035 Noe, 1974, The surgical construction of male genitalia for the female-to-male transsexual, Plast Reconstr Surg, 53, 511, 10.1097/00006534-197405000-00001 Puckett, 1978, Construction of male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device, Plast Reconstr Surg, 61, 523, 10.1097/00006534-197804000-00005 Khouri, 1998, Long-term results of total penile reconstruction with a prefabricated lateral arm free flap, J Urol, 160, 383, 10.1016/S0022-5347(01)62901-X Meyer, 1986, One-stage phalloplasty in transsexuals, Ann Plast Surg, 16, 472, 10.1097/00000637-198606000-00004 Hage, 1996, Fibula free flap phalloplasty: Modifications and recommendations, Microsurgery, 17, 358, 10.1002/(SICI)1098-2752(1996)17:7<358::AID-MICR3>3.0.CO;2-C Zieliński, 1999, Phalloplasty using a lateral groin flap in female-to-male transsexuals, Acta Chir Plast, 41, 15 Fang, 1999, Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: A series of 22 cases, Br J Plast Surg, 52, 217, 10.1054/bjps.1998.3027 Santanelli, 2000, Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap, Plast Reconstr Surg, 105, 1990, 10.1097/00006534-200005000-00012 Felici, 2006, A new phalloplasty technique: The free anterolateral thigh flap phalloplasty, J Plast Reconstr Aesthet Surg, 59, 153, 10.1016/j.bjps.2005.05.016 Bettocchi, 2005, Pedicled pubic phalloplasty in females with gender dysphoria, BJU Int, 95, 120, 10.1111/j.1464-410X.2004.05262.x Ranno, 2007, An objective evaluation of contraction power of neo-phallus reconstructed with free re-innervated LD in female-to-male transsexuals, Acta Chir Plast, 49, 8 van der Sluis, 2017, Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction, Microsurgery, 37, 917, 10.1002/micr.30190 De Wolf, 2019, Free bipedicled radial forearm and posterior interosseous artery perforator flap phalloplasty, J Sex Med, 16, 1111, 10.1016/j.jsxm.2019.03.270 Dabernig, 2006, Phalloplasty with free (septocutaneous) fibular flap sine fibula, J Urol, 176, 2085, 10.1016/j.juro.2006.07.036 Pigot, 2020, Genital gender-affirming surgery without urethral lengthening in transgender men-a clinical follow-up study on the surgical and urological outcomes and patient satisfaction, J Sex Med, 17, 2478, 10.1016/j.jsxm.2020.08.004 Chen, 2021, An option for shaft-only gender-affirming phalloplasty: Vaginal preservation and vulvoscrotoplasty. A technical description, Plast Reconstr Surg, 147, 480, 10.1097/PRS.0000000000007579 Selvaggi, 2007, Genital sensitivity after sex reassignment surgery in transsexual patients, Ann Plast Surg, 58, 427, 10.1097/01.sap.0000238428.91834.be Ranno, 2007, Neo-phalloplasty with re-innervated latissimus dorsi free flap: A functional study of a novel technique, Acta Chir Plast, 49, 3 Papadopulos, 2008, The use of free prelaminated and sensate osteofasciocutaneous fibular flap in phalloplasty, Injury, 39, S62, 10.1016/j.injury.2008.05.019 Leriche, 2008, Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism, BJU Int, 101, 1297, 10.1111/j.1464-410X.2007.07362.x Schaff, 2009, A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: Experience in 37 patients, Microsurgery, 29, 413, 10.1002/micr.20647 Kjölhede, 2019, Metoidioplasty and groin flap phalloplasty as two surgical methods for the creation of a neophallus in female-to-male gender-confirming surgery: A retrospective study comprising 123 operated patients, JPRAS Open, 22, 1, 10.1016/j.jpra.2019.07.003 Chang, 1984, Forearm flap in one-stage reconstruction of the penis, Plast Reconstr Surg, 74, 251, 10.1097/00006534-198408000-00014 Monstrey, 2009, Penile reconstruction: Is the radial forearm flap really the standard technique?, Plast Reconstr Surg, 124, 510, 10.1097/PRS.0b013e3181aeeb06 Kim, 2010, A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery, Ann Plast Surg, 64, 759, 10.1097/SAP.0b013e3181a5b719 Gottlieb, 1993, A new design for the radial forearm free-flap phallic construction, Plast Reconstr Surg, 92, 276, 10.1097/00006534-199308000-00012 Salgado, 2016, Immediate pedicled gracilis flap in radial forearm flap phalloplasty for transgender male patients to reduce urinary fistula, J Plast Reconstr Aesthet Surg, 69, 1551, 10.1016/j.bjps.2016.05.011 Veerman, 2020, Functional outcomes and urological complications after genital gender affirming surgery with urethral lengthening in transgender men, J Urol, 204, 104, 10.1097/JU.0000000000000795 Al-Tamimi, 2020, The first experience of using the pedicled Labia Minora flap for urethral lengthening in transgender men undergoing anterolateral thigh and superficial circumflex iliac artery perforator flap phalloplasty: A multicenter study on clinical outcomes, Urology, 138, 179, 10.1016/j.urology.2019.10.041 Bouman, 1987, The first step in phalloplasty in female transsexuals, Plast Reconstr Surg, 79, 662, 10.1097/00006534-198704000-00038 Cohen, 2020, Robotic excision of vaginal remnant/urethral diverticulum for relief of urinary symptoms following phalloplasty in transgender men, Urology, 136, 158, 10.1016/j.urology.2019.11.027 Hage, 1993, Preconstruction of the pars pendulans urethrae for phalloplasty in female-to-male transsexuals, Plast Reconstr Surg, 91, 1303, 10.1097/00006534-199306000-00017 Rohrmann, 2003, Urethroplasty in female-to-male transsexuals, Eur Urol, 44, 611, 10.1016/S0302-2838(03)00356-7 Zhang, 2015, Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?, World J Urol, 33, 2115, 10.1007/s00345-015-1562-z Thompson, 1971, Results of vaginal flap urethroplasty in hermaphrodites, J Urol, 105, 456, 10.1016/S0022-5347(17)61548-9 Fang, 1998, Glans sculpting in phalloplasty–Experiences in female-to-male transsexuals, Br J Plast Surg, 51, 376, 10.1054/bjps.1997.0220 Akhoondinasab, 2020, The comparison of a new durable coronaplasty technique with norfolk method for glans reconstruction after phalloplasty, World J Plast Surg, 9, 39 Sengezer, 1993, Scrotal construction by expansion of labia majora in biological female transsexuals, Ann Plast Surg, 31, 372, 10.1097/00000637-199310000-00016 Pigot, 2019, Surgical outcomes of neoscrotal augmentation with testicular prostheses in transgender men, J Sex Med, 16, 1664, 10.1016/j.jsxm.2019.07.020 Selvaggi, 2009, Scrotal reconstruction in female-to-male transsexuals: A novel scrotoplasty, Plast Reconstr Surg, 123, 1710, 10.1097/PRS.0b013e3181a659fe Hage, 1993, Constructing a scrotum in female-to-male transsexuals, Plast Reconstr Surg, 91, 914, 10.1097/00006534-199304001-00029 Pigot, 2020, Scrotal reconstruction in transgender men undergoing genital gender affirming surgery without urethral lenghtening: A stepwise approach, Urology, 146, 303, 10.1016/j.urology.2020.09.017 Falcone, 2018, Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery, BJU Int, 121, 139, 10.1111/bju.14027 Verla, 2021, Implantation of the ZSI 475 FTM erectile device after phalloplasty: A prospective analysis of surgical outcomes, J Sex Med, 18, 615, 10.1016/j.jsxm.2020.11.008 Hoebeke, 2010, Erectile implants in female-to-male transsexuals: Our experience in 129 patients, Eur Urol, 57, 334, 10.1016/j.eururo.2009.03.013 Neuville, 2016, Surgical outcomes of erectile implants after phalloplasty: Retrospective analysis of 95 procedures, J Sex Med, 13, 1758, 10.1016/j.jsxm.2016.09.013 van der Sluis, 2019, A retrospective cohort study on surgical outcomes of penile prosthesis implantation surgery in transgender men after phalloplasty, Urology, 132, 195, 10.1016/j.urology.2019.06.010 Chen, 2021, Infrapubic insertion of penile implants in transmen after phalloplasty, Urology, 152, 79, 10.1016/j.urology.2021.01.026 Large, 2009, Novel technique for proximal anchoring of penile prostheses in female-to-male transsexual, Urology, 74, 419, 10.1016/j.urology.2009.01.044 Neuville, 2019, First outcomes of the ZSI 475 FtM, a specific prosthesis designed for phalloplasty, J Sex Med, 16, 316, 10.1016/j.jsxm.2018.11.013 Pigot, 2020, Surgical experience and outcomes of implantation of the ZSI 100 FtM malleable penile implant in transgender men after phalloplasty, J Sex Med, 17, 152, 10.1016/j.jsxm.2019.09.019 Lin-Brande, 2021, Metoidioplasty with urethral lengthening: A stepwise approach, Urology, 147, 319, 10.1016/j.urology.2020.09.013 Djordjevic, 2009, Urethral Lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap, Urology, 74, 349, 10.1016/j.urology.2009.02.036 Takamatsu, 2009, Labial ring flap: A new flap for metaidoioplasty in female-to-male transsexuals, J Plast Reconstr Aesthet Surg, 62, 318, 10.1016/j.bjps.2008.11.038 Perovic, 2003, Metoidioplasty: A variant of phalloplasty in female transsexuals, BJU Int, 92, 981, 10.1111/j.1464-410X.2003.04524.x Hage, 2006, Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals, Ann Plast Surg, 57, 312, 10.1097/01.sap.0000221625.38212.2e Djordjevic, 2009, Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience, J Sex Med, 6, 1306, 10.1111/j.1743-6109.2008.01065.x Djordjevic, 2013, Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery, J Sex Med, 10, 1431, 10.1111/jsm.12108 Vukadinovic, 2014, The role of clitoral anatomy in female to male sex reassignment surgery, Scientific World J, 2014, 10.1155/2014/437378 Cohanzad, 2016, Extensive metoidioplasty as a technique capable of creating a compatible analogue to a natural penis in female transsexuals, Aesthetic Plast Surg, 40, 130, 10.1007/s00266-015-0607-4 Hage, 1996, Metaidoioplasty: An alternative phalloplasty technique in transsexuals, Plast Reconstr Surg, 97, 161, 10.1097/00006534-199601000-00026 Lebovic, 1999, Metoidioplasty, 355 Djordjevic, 2019, Metoidioplasty: Techniques and outcomes, Transl Androl Urol, 8, 248, 10.21037/tau.2019.06.12